Clinical Significance Of Detection Of Exfoliated Cancer Cells In Abdominal Cavity Before And After Laparoscopic Surgery For Advanced Gastric Cancer

Objectives: To explore the independent risk factors of intraperitoneal implantation metastasis of advanced gastric cancer.Methods: A total of 98 patients with advanced gastric cancer who met the admission criteria in the Department of Gastrointestinal Oncology,affiliated Hospital of Qinghai University from November 2018 to January 2020 were collected and confirmed by endoscopy and pathology.prospective abdominal exfoliative cancer cells were detected before and after laparoscopic surgery,and the positive rate of free cancer cells in peritoneal lavage fluid was obtained.The potential related factors of AGC-PM were analyzed by univariate and multivariate analysis to explore the independent risk factors of tumor cell exfoliation and intraperitoneal metastasis of gastric cancer.Results: The results showed that there were a total of 17 cases with positive cases of IFCCs before operation,and the remaining 81 cases were negative,with a positive rate of 17.3%.Laparoscopic assisted gastric cancer radical surgery,test positive for celiac lavage IFCCs cases for 24 cases,the remaining 74 cases were negative,positive rate was 24.5%,more than before laparoscopic operation in 7 cases(P < 0.05),and preoperative IFCCs test positive patients,postoperative IFCCs test is positive,so it is concluded that this study celiac lavage IFCCs detection of total positive rate was 24.5%.Univariate analysis(preoperative):AGC-PM was correlated with T(P = 0.001),TNM(P = 0.013),serous membrane invasion(P = 0.000),serous membrane invasion area(P = 0.029),and differentiation degree(P = 0.049).Univariate analysis(postoperative): T(P = 0.001),N(P = 0.03),TNM(P = 0.004),serous membrane invasion(P = 0.000),serous membrane invasion area(P = 0.027),and differentiation degree(P = 0.018).Multivariate analysis(preoperative):Tumor invasion depth(T stage)(P=0.020,OR=4.514,95%CI=1.271~16.028),Pathological TNM stage(P=0.025,OR=5.000,95%CI=1.229~20.339),Serous invaded(P=0.004,OR=5.521,95%CI=1.712~17.802),Serosa invasion area(>25cm~2)(P=0.036,OR=3.447,95%CI=1.082~10.978)are independent risk factors for AGC-PM.Multivariate analysis(postoperative):Tumor invasion depth(T stage)(P=0.018,OR=4.596,95%CI=1.293~16.334),Lymph node metastasis(N stage)(P=0.016,OR=7.441,95%CI=1.455~38.049),Pathological TNM stage(P=0.013,OR=4.654,95%CI=1.389~15.588),Serous invaded(P=0.000,OR=14.444,95%CI=4.816~43.319),Serosa invasion area(>25cm~2)(P=0.032,OR=3.100,95%CI=1.105~8.701)are independent risk factors for AGC-PM.Conclusions: 1.T,N,TNM stage,serous membrane invasion,serous membrane invasion area > 25cm~2 are independent risk factors for the occurrence of AGC-PM.Clinically,patients with the above high-risk factors,especially in low-oxygen plateau areas,should be more vigilant about the occurrence of PM;2.Laparoscopic surgery itself may be a risk factor for the occurrence of AGC-PM,which needs to be further confirmed.In clinical application,caution should be taken in the grasp of its indications.